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Saturday 20 April 2024

Peer Reviewed

Gastroenterology clinic

Amiodarone hepatoxicity

Jessica Howell, Amanda Nicoll

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Abstract

Liver and lung toxicity associated with the use of amiodarone is uncommon but potentially life-threatening. Hepatotoxicity may be reversible if the drug is ceased as soon as toxicity is suspected.

Key Points

Remember

Amiodarone hepatotoxicity can occur even on low-dose amiodarone therapy.
There is a significant mortality and morbidity (approximately 1%).
It can present as acute or chronic liver disease, early or late in the course of therapy (see the case studies in the box on page 58).
The risk increases with higher doses and longer durations of therapy.
The indication for amiodarone should be reviewed and other agents considered.
Monitoring of liver function tests (one to three-monthly) is recommended throughout the duration of amiodarone therapy and for 12 months beyond cessation.
Amiodarone should be ceased if the patient’s serum alanine aminotransferase (ALT) level is more than three times the normal for the testing pathology laboratory (i.e. is above about 150 U/L).